Orange County NC Website
ORANGE COUNTY—CONTRACT CONTROL SHEET <br /> Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk <br /> This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specifiec.above. If the Manager <br /> determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for <br /> BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should <br /> be completed through the legal review process prior to being routed for signature. <br /> Department <br /> Party/Vendor Name: Senior Care of Orange CounV Inc Party/Vendor Contact Person: Alvonia Baldwin Contact Phone: <br /> Party/Vendor Address: 105 Meadowlands Dr. City Hillsboroueh State:NC Zip:27278 Department:A in Amount: $10,000.00 <br /> Purpose:Respite Care Budget Code(s): 10432020-630100 Vendor#52717 (N/A if new vendor) Vendor is a BOCC consultant? Yes <br /> ❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 7/01/14 Approvec by Board Yes❑No <br /> ❑ Agenda Date: Title of Contract: Caregiver Respite <br /> If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No❑. If submitted for bid were <br /> bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: —.1 Date: <br /> IT Director <br /> (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the Information <br /> Technology Director as to technical content and information technology specifications: <br /> IT Director's Signature: Date: <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurawe Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as ed <br /> by the Risk Manager: <br /> Risk Manager's Signature: Jam_ Date: JUN 2 3 2014 <br /> L.1 Z4 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑ /NoE ary <br /> before approval Yes❑No[ If budget amendment is necessary,please attach to this form. This instrument hz,s been pre-audited in the <br /> manner required by the Local Government Budget and Fiscal Control Act: 1y I <br /> Financial Services Director's Signature: � µ' Date:_/ 2� <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000.0 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval by Manager[(Most other contracts$1,000 and above). Department Director approval only❑(Under <br /> $1,000). This contract has b evi d approved by the Attorney as to legal form and suffic'enc . <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes❑No❑. <br /> This contract has been reviewed and is for signature b he Chair Yes❑No❑. <br /> Manager's Signature: Date: <br /> Cle to the Board <br /> Approved by BOCC on the_day of ,20 . Submitted for Chair signature on the_day o1' 120 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />